The present devices relate to medical devices, and in particular to electrosurgical devices having a conductive component such as a bipolar or monopolar device.
In endoscopic, or other minimally invasive surgery, generically referred to herein as endoscopic surgery, a sphincterotome may be used in conjunction with an endoscope to provide surgical cutting inside a patient. Specifically, a sphincterotome is used during certain procedures to make an incision in a sphincter. For example, a common treatment of cholecystitis includes the removal of gallstones from the common bile duct. This is frequently done endoscopically with the use of a duodenoscope. The common bile duct proceeds from the junction of the common hepatic duct with the cystic duct, which is open to the gall bladder, and merges with the pancreatic duct, forming the ampulla of Vater, which itself opens into the duodenum at the papilla of Vater. The sphincter of Oddi is a muscular ring that controls passage of fluid from the ampulla of Vater into the duodenum. For removal of gallstones in an endoscopic procedure, access to the common bile duct for removal of gallstones is eased using a sphincterotome to incise or sever the sphincter of Oddi. The sphincterotome is introduced through the duodenoscope and guided through the duodenum to the common bile duct. Once the sphincterotome is guided into the sphincter, its cutting element, commonly a cutting wire, is used to incise the sphincter, and thereby improve access to the bile duct and impacted gallstones.
Another example of a common procedure utilizing a sphincterotome is endoscopic retrograde cholangiopancreatography (ERCP), a diagnostic visualization technique used for a variety of clinical applications. In this procedure, a contrast fluid such as a radio-opaque dye is introduced through a tube into the ampulla of Vater. A sphincterotome is often employed to provide access through the sphincter of Oddi. ERCP is often used in diagnosis of cholecystitis, as well as in the diagnosis and treatment of other conditions of the pancreatic and common bile ducts and related structures.
One problem associated with the use of a cutting wire on a sphincterotome or other device is that the cutting wire is difficult to orient for cannulation and cutting of the sphincter. The correct orientation of the cutting wire relative to the sphincter is important for proper cutting of the sphincter to provide access through the sphincter. In addition, the sphinctertome or other device may be used to navigate into smaller branches of the ductal system where rotation of the cutting wire may be necessary to provide access to the desired ducts. Rotation of the cutting wire may be difficult due twisting of the wire relative to other features of the device. For example, in a bipolar device, the cutting wire when rotated may cross over the return wire.
What is needed in the art is a sphincterotome that is rotatable to properly orient the cutting wire anchored to the distal portion of the sphincterotome relative to the tissue. The cutting wire should be rotatable without interference from other portions of the device.